Navigation Links
NCPA Endorses Bipartisan Bill to Address Egregious Pharmacy Audit, Reimbursement Tactics in Medicare
Date:5/7/2013

ALEXANDRIA, Va., May 7, 2013 /PRNewswire-USNewswire/ -- Bipartisan legislation that would let pharmacists devote more time to Medicare beneficiaries and less to haggling with drug benefit middlemen over clerical issues and below-cost payments for generic drugs was introduced in the U.S. Senate and won the backing of the National Community Pharmacists Association (NCPA) today.

(Logo: http://photos.prnewswire.com/prnh/20100106/DC33253LOGO)

"Patients trust independent community pharmacists for the expert medication counseling and other services that they provide, such as immunizations and diabetes counseling," said B. Douglas Hoey , RPh, MBA. "Unfortunately, these pharmacist, small business owners face an increasing number of indefensible barriers to providing the level of care that their patients deserve and have come to expect. Often this is due to the unchecked authority that pharmacy benefit managers (PBMs) have over community pharmacies. This bipartisan legislation would achieve a more balanced business relationship between PBMs and community pharmacies and thereby allow pharmacists to continue putting patients first in health care."

The Medicare Prescription Drug Program Integrity and Transparency Act (S. 867) was introduced by U.S. Senators Mark Pryor (D-Ark.) and Jerry Moran (R-Kan.). It would focus pharmacy audits on uncovering actual fraud and abuse, bring transparency to generic drug reimbursement rates and give Medicare beneficiaries additional privacy and other protections.

First, the bill would rein in abusive audit tactics and ensure that any legitimately recouped funds are passed on to Medicare, not pocketed by middlemen. While Part D pharmacy audits are necessary to detect fraud and abuse, drug plan intermediaries such as pharmacy benefit managers (PBMs) are abusing this process by singling out expensive drugs and using typographical and other trivial errors to recoup from pharmacies significant amounts that are not always necessarily returned to the Medicare program. Twenty-four states have adopted similar legislation.

"When a pharmacist gives a patient the right medication at the right time, at the right cost, it should not be a punishable offense," Hoey said. "Audits, of course, must be conducted, but they should not be exploited by middlemen at the expense of Medicare and the taxpayer."

Second, the bill would increase transparency into generic drug payment rates. To continue serving most patients, pharmacists must sign contracts with Part D plans and/or PBMs. However, the contracts are non-negotiable and do not disclose the terms and conditions regarding payments for most generic drugs, which account for nearly 80 percent of drugs dispensed. Increasingly, pharmacies are being paid below their costs to dispense and the reimbursement limits, or Maximum Allowable Cost (MAC), is not updated frequently to reflect generic drug price spikes. The legislation would allow a pharmacy to know how its individual MAC rates would be determined (but not those of other pharmacies in that particular health plan's pharmacy network) and require payments to be updated more frequently to keep pace with actual market costs.

Third, the bill would give Medicare beneficiaries additional privacy protections and greater choice of pharmacy. PBMs could not transmit personally identifiable utilization or claims data to a PBM-owned pharmacy unless the patient has voluntarily elected to fill their prescription at such pharmacy. In addition, PBMs would be banned from requiring that a beneficiary use a retail or mail order pharmacy in which the PBM has an ownership interest.

"We commend Senators Pryor and Moran for their work on this legislation," added Hoey. "This bill would address some of the most challenging roadblocks to pharmacists providing even better patient care. Community pharmacists should get engaged at the grassroots level and encourage their Members of Congress to support this legislation."

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies. Together they represent an $88.5 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com/.


'/>"/>
SOURCE National Community Pharmacists Association
Copyright©2012 PR Newswire.
All rights reserved

Related medicine technology :

1. Parent Project Muscular Dystrophy Endorses Senate Version of Prescription Drug User Fee Act After Patient Voice Strengthened
2. Bipartisan Group of 124 Lawmakers Express Concern That Medicare Cuts to Life-Sustaining Cancer Drugs Threatening Patient Care
3. Frost & Sullivan Recognizes Labcyte for its Commitment to Innovation and Addressing Unmet Needs in the Liquid Handling Market
4. Student of Liver And Vascular Surgery of West China Hospital of Sichuan University Addresses The 18th ILTS Annual Meeting in the United States
5. PeaceHealth Laboratories New Patent Addresses a Leading Cause of Death: Prescription Drug Abuse
6. AUA Foundation Launches Campaign to Address Stigma of Overactive Bladder
7. ACEP Commends Congress For Passing Legislation That Addresses Drug Shortages As Well As "Bath Salts"
8. ViiV Healthcare Expands Commitment to Addressing Gaps in Paediatric HIV Research, Care and Treatment
9. Aethlon Medical Discusses Therapeutic Device Strategies to Address Cancer, Hepatitis-C and Sepsis with the Wall Street Transcript
10. Generex Addresses Recent Trading Volume in Shares of its Common Stock
11. Top FDA Official Stephen P. Spielberg, MD, PhD, to Deliver Plenary Address at 2012 ISPE Annual Meeting
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... 2016 Dublin ... addition of the " Global Markets for Spectroscopy ... This report focuses on the ... review, including its applications in various applications. The report ... includes three main industries: pharmaceutical and biotechnology, food and ...
(Date:6/24/2016)... 2016 The Academy of Managed Care Pharmacy ... that would allow biopharmaceutical companies to more easily share ... formulary and coverage decisions, a move that addresses the ... The recommendations address restrictions in the sharing ... drug label, a prohibition that hinders decision makers from ...
(Date:6/24/2016)... SAN CLEMENTE, Calif. , June 24, 2016  American ... function testing company, is now able to perform sophisticated lung assessments ... ndd Medical Technologies , Inc. Patients are no ...  Thanks to ndd,s EasyOne PRO ® , ARL patients like Jeanne ... needed testing done in the comfort of her own home. ...
Breaking Medicine Technology:
(Date:6/27/2016)... , ... June 27, 2016 ... ... the patient payment industry today announced its strategic partnership with Connance, a ... workflows. , The two companies’ proven, proprietary technology combine to provide health ...
(Date:6/26/2016)... (PRWEB) , ... June 26, 2016 , ... On June ... sponsor of the 2016 Cereal Festival and World’s Longest Breakfast Table in Battle Creek, ... of the city’s history as home to some of the world’s leading providers of ...
(Date:6/26/2016)... ... June 26, 2016 , ... Many women ... diagnosed with endometriosis. These women need a treatment plan to not only alleviate ... that can help for preservation of fertility and ultimately achieving a pregnancy. The ...
(Date:6/25/2016)... California (PRWEB) , ... June 25, 2016 , ... "With ... fit their specific project," said Christina Austin - CEO of Pixel Film Studios. ... customizable and all within Final Cut Pro X . Simply select a ProHand ...
(Date:6/25/2016)... (PRWEB) , ... June 25, 2016 , ... On Friday, ... presented a Bronze Wellness at Work award to iHire in recognition of their exemplary ... part of the 7th annual Maryland Workplace Health & Wellness Symposium at the BWI ...
Breaking Medicine News(10 mins):